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Abstract Background Major depressive disorder is one of the most common psychiatric disorders, which is associated with a high disease burden. Current treatments using antidepressants have limitations, so using medication with neuromodulating and anti-inflammatory properties alongside them could be helpful. In a clinical trial, we studied the effectiveness of empagliflozin, a blood sugar-lowering drug, as an adjunctive therapy to reduce the severity of depression symptoms. Methods A number of outpatients with moderate to severe depression (Hamilton Depression Rating Scale (HDRS) > = 17) who were not under related medication or had not taken medication for at least the last two months, had an age range of 18–60 years and had written informed consent to enter the study (N = 90) were randomly divided into two groups receiving placebo or empagliflozin (10 mg daily) combined with citalopram (40 mg daily) based on permuted block randomization method in an 8-week randomized, double-blind, placebo-controlled clinical trial. They were evaluated using the HDRS in weeks 0, 4, and 8. Results HDRS scores were equal to 28.42(± 3.83), 20.20(± 3.82), and 13.42(± 3.42) in the placebo group during weeks 0,4, and 8, respectively. These scores were 27.36(± 3.77), 13.76(± 1.40), and 7.00(± 1.13), respectively, for the group treated with empagliflozin. Compared to the control group, patients treated with empagliflozin using repeated-measures ANOVA showed greater improvement in reducing the severity of depression symptoms over time (p value = 0.0001). Conclusions Considering the promising findings in this clinical trial, further study of empagliflozin as adjunctive therapy in MDD with larger sample sizes and longer follow-ups is recommended.

Background: The correlation between psychosis and bipolar disorder is a crucial and complex matter that requires attention and study. In this study, researchers examined the relationship between the current episode status, substance use disorder, different types of substance use, and psychotic symptoms in inpatients with bipolar disorder. Methods: The study included 150 patients who were diagnosed with bipolar disorder based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). These patients were referred to the emergency department of Roozbeh Psychiatric Hospital in Iran between November 2019 and February 2020. The Structured Clinical Interview for the DSM-5 (SCID-5) questionnaire was used to diagnose the patient's bipolar disorder, including episodes of depression and mania, as well as their substance use disorder. The type of substance used and the pattern of its use were also evaluated using this questionnaire. Additionally, a faculty member of the psychiatry department at Tehran University of Medical Sciences carefully evaluated the patient's condition for the presence of psychotic symptoms using a psychiatric diagnostic interview. Results: Out of 150 inpatients diagnosed with bipolar disorder, 89 (59.3 %) had comorbid substance use disorder. Among these 89 patients, 42 (47.2 %) had psychotic symptoms, whereas 79 (52.7 %) of the total 150 inpatients had psychotic symptoms. There was no significant relationship between substance use disorder (p-value=0.86), the type of substance used in a recent episode (p-value=0.93), and the current episode type (p-value=0.69) with psychotic symptoms. Limitations: The study's generalizability is limited to hospital patients with bipolar disorder. Additionally, since it was a cross-sectional study, causal interpretation was not possible. Conclusions: The study suggests a primary link between bipolar disorder and psychosis, independent of substance use. Longitudinal multicenter studies with larger sample sizes are recommended.

Background & Aims The present study aims to determine the fear of COVID-19 in the elderly newly diagnosed with cancer referred to selected hospitals affiliated to Alborz University of Medical Sciences. Materials & Methods In this longitudinal study, 174 elderly people newly diagnosed with cancer referred to the selected hospitals participated, who were selected using a continus sampling method. To collect data, a demographic form, the Abbreviated Mental Test, and the 7-item fear of COVID-19 scale were used before diagnosis, one month after, and two months after. The data were analyzed in SPSS software, version 22. Results Fear of COVID-19 level at the time of cancer diagnosis was moderate (mean score: 17.69±4.74). In the second stage (one month after the diagnosis), the mean score was 14.26±4.09. In the third stage (two months after diagnosis), the mean score was 11.81±4.13. Fear of COVID-19 at the time of cancer diagnosis was significantly different based on marital status (P=0.049), underlying diseases (P=0.014), and perception of health (P=0.004). Conclusion Fear of COVID-19 can disrupt the process of treatment and chemotherapy in elderly patients with cancer. It is recommended to develop interventions to improve the mental health of the elderly with cancer during the pandemic.

BackgroundWe sought to conduct this comprehensive systematic review and meta-analysis to assess the prevalence of depression, anxiety, and sleep disturbance in Iranian medical students and resident physicians.MethodsA systematic search was conducted on 23 December 2023 in PubMed/MEDLINE, Web of Science, Scopus, and Iranian national databases. We pooled the prevalence of individual studies using the random effect model.ResultsOur systematic search showed 36 articles that meet the eligibility criteria. Most included studies were cross-sectional. The most used questionnaire to assess depression, anxiety, and sleep disturbance were Beck Depression Inventory (BDI), The Depression, Anxiety and Stress Scale-21 Items (DASS-21), and The Pittsburgh Sleep Quality Index (PSQI), respectively. The overall prevalence of depression, anxiety, and sleep disturbance among Iranian medical students were 43% (95%CI: 33%-53%%, I2 = 98%), 44% (95%CI: 31%-58%%, I2 = 99%), 48% (95%CI: 39%-56%%, I2 = 97%), respectively. The results of subgroup and meta-regression analyses showed questionnaires used and the place of the medical school were significantly associated with the prevalence of aforementioned outcomes. Funnel plot and Begg's regression test did not show a significant source of funnel plot asymmetry for depression, anxiety, and sleep disturbance.ConclusionIn conclusion, our study showed that nearly half of the medical students had some type of depression, anxiety, and sleep disturbance problems. To address this serious national public health issue, efficient preventive measures, routine screenings, and prompt interventions are required.

Abstract Introduction Treatment of mood and cognitive symptoms of patients with bipolar disorder is associated with many complications and is generally not associated with therapeutic satisfaction. In this clinical trial, we evaluated the effectiveness of spironolactone in controlling mood and cognitive symptoms, sleep quality, appetite, and body mass index in patients with bipolar disorder in manic episodes. Methods Sixty inpatients with bipolar disorder in manic episodes were treated with spironolactone/placebo in an 8‐week randomized, double‐blind, placebo‐controlled clinical trial. They were evaluated using the Young Mania Rating Scale (YMRS), mini‐mental state examination (MMSE), Pittsburgh sleep quality index, Simplified Nutritional Appetite Questionnaire, and body mass index in weeks 1, 4, and 8. Results For cognitive impairment (MMSE), there were significant interaction effects of group and time at week 8 (B = −1.60, SE = 0.69, t = −2.33, p = .021) such that individuals in the spironolactone group experienced more improvement in their cognitive performance. For manic symptoms (YMRS), there were no significant interaction effects of group and time at week 8 (B = −2.53, SE = 1.46, t = −1.73, p = .085). Conclusions Considering the promising findings in this clinical trial, further study of spironolactone as adjunctive therapy in bipolar disorder in manic episodes with larger sample sizes, multicenter settings, and longer follow‐ups are recommended.

BackgroundDuring the COVID-19 pandemic, Health Care Workers (HCWs) were more vulnerable than ever to Burnout and Suicidal thoughts due to stressful work conditions. This study, investigated the level of Burnout and Suicidal thoughts among HCWs during the fourth wave of the pandemic in Alborz Province in Iran and compared it with the conditions at the beginning of the pandemic.MethodsA total of 305 HCWs from 3 referral hospitals for COVID-19, including 155 men and 150 women, participated in the study. A cross-sectional study was carried out with a sample of HCWs dealing with COVID-19 patients using the available sampling method. The results of this online survey, which was conducted from June 7 to July 5, 2021 (at the end of the Fourth Wave of the COVID-19 Pandemic in Iran), have been compared with the conditions of the First Wave of the Pandemic (from February 24 to April 27, 2020). The participants were evaluated by the Beck Scale for Suicidal Ideations (BSSI) and Maslach Burnout Inventory (MBI).ResultsThe mean age of the participants was 36.34 ± 7.37. The means of Suicide Index (SI), Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) scores were 0.76 ± 1.74, 19.94 ± 4.69, 4.92 ± 1.51, and 31.30 ± 5.88, respectively. SI and PA were significantly higher in workers other than nurses and physicians and EE was higher among workers with night shifts (p value

Background: Mental health education aims to increase mental health literacy (MHL) and plays a crucial role on mental health of community members. However, its implementation in primary health care (PHC) faces obstacles and problems. Therefore, this study was conducted to explain the challenges of the public mental health education program with an emphasis on self-care in Iran's PHC. Methods: This was a qualitative study with a content analysis approach. The research sample consisted of 20 stakeholders through purposive sampling with maximum diversity. This study was conducted in Tehran and Alborz, Iran. Data were collected through in-depth and semi-structured interviews and analyzed by Graneheim and Lundman approach. Results: By analyzing data, the challenges were categorized into six main themes and 15 categories. The six main themes included educational challenges, inefficiency of the educational method, unsuitable intersectoral collaboration, infrastructural challenges, inadequate resources and barriers to participation in education. Conclusions: Given multidimensionality challenges and obstacles, reform and adoption of appropriate implementation methods using mental health experts seem necessary. Future research and policies could explore ways to optimize program implementation in PHC.

Abstract Background Attention Deficit Hyperactivity Disorder (ADHD) constitutes a prevalent behavioral problem. The present study examined the parent–child relationship model and investigated strategies to cope with behavioral problems in children with ADHD. Methods This descriptive study selected 300 children with ADHD using convenience sampling. The data collected using the child behavior checklist, the parent–child relationship scale (PCRS), the Billings and Moos Coping Checklist, the socioeconomic status questionnaire, the general health questionnaire-28 (GHQ-28) and a demographic checklist were analyzed in SPSS-25 and LISREL 8.8. Results According to the results of the path analysis on the relationship model among parent–child relationship domains, coping responses and children's behavioral problems, parent–child dependency domain (B = 0.22) in the direct path, disease duration (B = 0.085) in the indirect path, and conflicts in the domain of parent–child relationship (B = 0.366) in both direct and indirect paths had the most positive causal effect on behavioral problems. Furthermore, intimacy in the said domain (B = -0.42) had the most negative causal effect in both direct and indirect paths. The extent to which parents used coping responses via the direct path had a positive causal effect on behavioral problems (B = 0.12). Based on the path analysis test findings in the relationship model among positive parent–child relationship, coping responses and children's behavioral problems, the positive parent–child relationship score had the most negative causal effect via the direct path (B = -0.56). Conversely, the child's age had the highest positive causal effect via the indirect path (B = 0.1) on behavioral problems in children. Conclusion Based on findings, there is a causal and significant relationship between the parent–child relationship and the extent to which coping responses are used. It is recommended that training programs be developed to strengthen communication skills, coping responses and problem-solving techniques in parents.

Abstract Backgrounds The study of the relationship between adult Attention deficit hyperactivity disorder (ADHD) and bipolar disorder has received more attention in recent years and there is limited information in this area. On the other hand, there is a significant comorbidity between ADHD and bipolar disorder with substance use disorder. In this study, we investigated the prevalence of comorbidity of adult ADHD and substance use disorder among a group of bipolar patients admitted to a psychiatric hospital. Methods One hundred fifty patients from a total of 200 consecutive patients who were referred to the emergency department of Roozbeh Psychiatric Hospital in Tehran, diagnosed with bipolar disorder based on the initial psychiatric interview and needed hospitalization, were evaluated again by an experienced faculty member psychiatrist by using a subsequent interview based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition(DSM-5). They were evaluated using the Structured Clinical Interview for DSM-5 (SCID-5) questionnaire to confirm the diagnosis of bipolar disorder and the comorbidity of adult ADHD and substance use disorder. Results From 150 patients diagnosed with bipolar disorder, 106 patients (70.7%) had adult ADHD. 89 patients (59.3%) had substance use disorder and 58 patients (38.7%) had both of these comorbidities with bipolar disorder. Comorbidity of adult ADHD was associated with the earlier onset of the first mood episode in bipolar disorder (p value = 0.025). There was no statistically significant relationship between substance use disorder and age of onset of the first episode. (P value = 0.57). Conclusions Due to the limitations of studies on adult ADHD comorbidity with bipolar disorder, especially in hospital settings, as well as the increased risk of association with substance use disorder, further multicenter studies in this area with larger sample sizes can increase awareness in this regard.

BackgroundStigma can be seen as a mark of disgrace that can lead to the separation of one person from another. In this qualitative study, we assess the status of stigma among in front-line health care workers (HCWs) during the first wave of the COVID-19 pandemic in Iran.Subjects and methodsThe participants were selected from frontline HCWs related to COVID-19 in Imam Ali and Imam Hossein referral hospitals in Alborz province, Iran. Study was conducted between May and June 2020. The 32-item checklist Consolidated Criteria for Reporting Qualitative Research (COREQ) was used to report this qualitative study. Interview questions were prepared based on the grounded theory method. The thematic approach was used to analyze the data content. Data analysis was based on open and axial coding and after implementing the codes in MAXQDA software.ResultsThe results of this study included 4 themes, 8 categories and 33 sub-categories. Themes included extrinsic and intrinsic elements of stigma, perplexity and stigma removal requirements. Extrinsic elements included “creating blame and shame” and “discrimination” categories. Intrinsic elements included “the desire to be avoidance,” “feeling depressed and frustrated” and “feeling anxious and scared” categories. Perplexity included “feeling loss” category. Stigma removal requirements included “factors causing stigma” and “protective agents against stigma” categories.ConclusionLow public awareness on COVID-19 and inadequate public care, limited personal protective equipment and inadequate facilities for HCWs along with lack of appreciation for their efforts, lack of proper psychiatric/psychological counseling to identify and treat symptoms associated with mental health and the limitations of training to maintain mental health skills are considered to be factors in the formation of stigma among HCWs related to COVID-19. Health policymakers should implement coherent strategies related to increasing public awareness and providing personal protection needs and counseling care for HCWs in relation to COVID-19.

Abstract In this study, while presenting a clinical case with early psychiatric manifestations, we emphasized the need to pay attention to neurological diagnoses such as Anti N‐Methyl‐D‐Aspartate Receptor (NMDAR) encephalitis at the time of manifestation of these common symptoms.

Abstract Background Studies have shown that health care workers (HCWs), as front liners of the coronavirus (COVID-19) pandemic, are at high risk for psychological symptoms, but few studies have compared these symptoms in infected and non-infected HCWs. This study compares psychological symptoms among these two groups. Methods In this cross-sectional study, 938 HCWs from various medical fields working in the leading general hospitals of Alborz province, Iran, were selected using a multistage sampling method. The participants had contact with COVID-19 patients. Post-traumatic stress disorder-8 (PTSD-8) is a validated questionnaire that we used to evaluate PTSD symptoms along with its subscales, including intrusion, avoidance, and hypervigilance. Also, the Depression, Anxiety, and Stress Scale-21 questionnaire was used to assess the severity of the aforementioned conditions in HCWs. Multivariate logistic regression was used to compare psychological symptoms in infected and non-infected HCWs. Results Among 938 included HCWs, 55 had a history of confirmed COVID-19 infection. Prevalence of stress, anxiety, depression, intrusion, hypervigilance, and avoidance among infected HCWs were significantly higher in comparison to non-infected HCWs. In the multivariate logistic model, history of COVID-19 infection among HCWs was associated with a significantly increased risk of anxiety, depression, stress, intrusion, hyper-vigilance, and avoidance. Conclusion The present study showed that the HCWs with COVID-19 infection were at a high risk of displaying psychological symptoms. Therefore, it is also necessary to develop psychological support and interventions for HCWs, especially those who got infected with the virus.

Objective: The mental health status of health care workers (HCWs) related to COVID-19 is of great importance. By designing cross sectional studies, we evaluated disorders related to the mental health of these health workers. Short-term and long-term diagnostic and treatment interventions are other components of this care protocol. Method: This study includes a collection of studies and interventions in the form of analytical cross sectional study at the level of educational hospitals of Alborz University of Medical Sciences. In this study, HCWs were evaluated for mental health disorders in quantitative and qualitative studies. Depression, Anxiety and Stress Scales (DAS), Posttraumatic Stress Disorder (PTSD) questionnaires, and Stigma questionnaire in quantitative studies with thematic approach in qualitative study were used to evaluate and analyze the data. Conclusion: A series of coherent measures have been taken to prevent, screen, and treat mental healt disorders of the staff who provide services to patients with COVID-19. We hope the results of these measures will be used as a guide for other professionals and academic and hospital centers in similar conditions to effectively control the disease and improve the mental health of HCWs.

Objective: Spironolactone (C24H32O4S), a potent mineralocorticoid receptor (MR) inhibitor, is a potassium-sparing diuretic that is traditionally used to treat fluid build-up in the body or for its anti-androgenic properties. This study is a double-blind, placebo-controlled, randomized clinical trial assessing the beneficial effects of spironolactone in addition to risperidone in improving negative symptoms of schizophrenia. Method: 40 patients with chronic schizophrenia, aged 18–60 years, were assigned to two groups: risperidone + spironolactone or risperidone + placebo. Risperidone was administered to both the spironolactone and placebo groups with a dose up to 6 mg/day throughout the trial. Spironolactone (C24H32O4S) was ordered 100 mg/day for the full 8-week course of the study. Patients were rated on the Positive and Negative Syndrome Scale (PANSS) at four time points: baseline, weeks two, four, and eight. The PANSS negative subscale score was the main objective. Results: PANSS negative, positive, and total scores showed significantly greater improvements in the spironolactone relative to the placebo group from baseline to the trial endpoint (P (Cohen’s d): 0.004 (0.96), 0.007 (0.90), and 0.042 (0.66), respectively). Similarly, ANOVA also presented significant time × treatment interaction effect for spironolactone on PANSS negative (F = 9.04; ηp2 = 0.19; df = 1.38; P = 0.002), positive (F = 3.43; ηp2 = 0.08; df = 2.72; P = 0.023), and total (F = 3.94; ηp2 = 0.09; df = 2.05; P = 0.022) scores. However, spironolactone did not cause significant decrease in the general psychiatric pathology score of PANSS. Conclusion: Our findings suggest the efficacy and safety of spironolactone as an adjunctive therapy to risperidone in improving the symptoms of schizophrenia.

Abstract Objective Vitamin B6 has been linked to a variety of probable roles, including anti‐inflammatory, homocysteine‐lowering, serotonin‐regulating, and dopamine‐lowering. In this study, we investigated the possible effect of vitamin B6 on bipolar disorder in manic episode with psychotic feature in a placebo‐controlled double‐blind clinical trial in a psychiatric hospital. Methods This study was performed on 50 patients who were equally divided into two groups (each group included 25 patients) using 80 mg of vitamin B6 daily or placebo. At the beginning and end of the study, they were evaluated for lab tests, inflammatory biomarkers and level of blood homocysteine. Also, at the baseline and in weeks 2, 4, and 8, they were evaluated based on the anthropometric measurements, score obtained from the Young Mania Questionnaire, Mini‐Mental State Examination (MMSE), and the Pittsburgh Sleep Questionnaire. Results Accordingly, based on Yang Mania scoring scale, no significant difference was observed between the two groups receiving vitamin B6 and placebo (22.68 ± 5.39 vs. 21.80 ± 5.39 [p‐value = .51]). Based on MMSE, significant improvement in cognitive status was obtained in group placebo compared to vitamin B6 group (25.24 ± 1.96 vs. 24.40 ± 3.25, respectively [p‐value = .01]). At the Pittsburg scale (total, there was no statistically significant difference between the two groups receiving vitamin B6 and placebo (1.04 ± 0.20 vs. 0.48 ± 0.50 [p‐value = .23]). Additionally, no significant difference was observed between the two groups regarding the anthropometric status. Conclusions According to this study, the daily dose of 80 mg of vitamin B6 for 8 weeks in patients with bipolar disorder in the manic episode with psychotic feature treated daily with lithium, was not associated with a significant improvement in mood status compared to the control–placebo group. It is recommended to perform similar studies in a multi‐center manner with a larger sample size and longer duration.

Abstract Chiari malformation may have possible effect on cognitive and affective demonstrations. It seems necessary to pay attention to the underlying anatomical conditions in terms of diagnostic and therapeutic aspects when evaluating neuropsychiatric manifestations.

Introduction: Creutzfeldt-Jakob disease (CJD) as a prion disease is an untreatable type of progressive neurodegenerative encephalopathy. Although no definitive case has been reported yet, here we report a case that given the history, course of symptoms, and recent dental practice, it is highly probable that it was caused by dental procedures. Case Report: The patient was a 52-year-old woman who has had memory problems gradually with forgetting the names of family members since 6 weeks prior to the visit and shortly after the dental procedure. She experienced progressive visual hallucinations accompanied by a sharp decline in cognitive, verbal, and motor abilities in just a few weeks. Finally, the diagnosis of Creutzfeldt-Jakob was made for her based on the clinical history and typical brain MRI. Discussion: Clinical evidence of this patient, along with positive brain MRI results, indicates the risk of prion transfer through dental procedures. Paying attention to the neurological aspects of psychiatric manifestations and increasing the awareness of dentists about how to deal with and act on the potential dangers of prion transfer is of paramount importance.

Objective: Major depressive disorder (MDD) is predicted to be the first cause of burden of disease. The antidepressant activity of gemfibrozil has been recently considered. This study was designed to evaluate the effectiveness of gemfibrozil as a sertraline adjunct in treating patients with MDD. Method: A total of 46 patients with MDD based on the DSM-V criteria with a minimum score of 22 on the 17-item Hamilton Rating Scale for Depression (HAM-D) were randomized to receive either 300 mg daily gemfibrozil or placebo in addition to 100 mg sertraline for 8 weeks in a randomized, double-blind placebo-controlled trial. Patients were evaluated for response to treatment using the HAM-D score at baseline and weeks 2, 4, and 8. Results: Forty-five patients completed the study and took part in all follow-up visits. Repeated measure ANOVA with a Greenhouse-Geisser correction showed a significant difference for time×treatment interaction on within-subjects HAM-D scores [p–value= 0.026]. A significant difference was seen in time [p–value < 0.001]. The test of between-subject effects also showed a significant effect of treatment on HAM-D scores at weeks 2, 4, and 8 [p–value = 0.07]. Using Kaplan-Meier estimate curves, time to remission periods were significantly different between the 2 trial arms [Log-Rank p–value = 0.003]. Conclusion: Gemfibrozil is an effective adjunctive treatment in MDD and can be used to reduce depression symptoms.

Objective: The global spread of COVID-19 has caused great psychological stress in health care workers (HCWs). This study aims to assess the prevalence and associated factors of posttraumatic stress symptoms (PTSS) and stigma among health care workers (HCWs) who are involved in treating COVID-19 patients. This study was conducted as part of studies related to assessing the mental health status of HCWs in Iran during the COVID-19 pandemic. Method: Overall, in this cross sectional study, 894 HCWs working in 9 general hospitals in Alborz province, Iran, in the field of diagnostic and treatment care of patients with COVID-19 were selected using multistage sampling method. PTSS and its subscales, including intrusion, avoidance, and hyper vigilance were obtained based on the Posttraumatic Stress Disorder-8 Item validated questionnaire. Information on Stigma's perception among HCWs was also obtained based on a questionnaire adopted from the HIV Stigma Scale. Predictors of PTSS and Stigma's perception among HCWs were assessed using multivariate logistic regression analysis. Results: Overall, 71.4% of the participants were women and 46.9% were front line staff. The prevalence of intrusion, avoidance, and hyper vigilance symptoms was 44.2% (95% CI: 40.8-47.6), 31. 8% (95% CI: 28.8-35.0), and 37.7% (95% CI: 34.5-41.0), respectively. A strong and positive significant correlation was found between stigma score with PTSD total score (coefficient: 0.83) and its components. In multivariate logistic regression model, female gender was associated with intrusion (OR: 1.46, 95% CI: 1.03-2.06) and avoidance (OR: 1.66, 95% CI: 1.147-2.417) and working in frontline increased the odds of intrusion (OR: 1.45, 95% CI: 1.06-1.97) and hyper vigilance (OR: 1.41, 95% CI: 1.03-1.91). Conclusion: The prevalence of PTSS is high among HCWs during COVID-19 pandemic and it is associated with some demographic characteristics of HCWs. This situation should be considered by health policymakers so that while trying to control the disease, the mental health status of this group of personnel should be given much attention.

In the last couple of years, with the advancement of imaging methods, the diagnosis of gray matter heterotopia has been more promising. Gray matter heterotopia is a rare disorder in the general population, but recent attention to its psychiatric aspects encouraged us to introduce a patient with a form of gray matter heterotopia, who suffers from the anatomical abnormalities with a variety of psychiatric disorders. Our patient is a 25-year-old woman, who presented a variety of organogenesis disorders such as imperforate anus and rectovaginal fistula with the presence of gray matter heterotopia and history of refractory mood and psychotic disorders during 9 past years. Because of the various clinical manifestations of the disease, syndromic attention to this disease seems to be helpful in diagnosing and treating its various aspects.

Objective: Selective serotonin reuptake inhibitors (SSRIs) have been the most widely used psychopharmacological agents prescribed for depression worldwide. Some adverse effects of SSRI drugs on central nervous system are insomnia and bruxism. These drugs also affect sleep. Quetiapine is used as adjunctive therapy to antidepressants for the treatment of major depressive disorder (MDD). It is a low- dose dibenzothiazepine with more potent 5-HT2 than D2 receptor-blocking properties that can be used to manage bruxism because of its antagonist effect on the 5-HT2 receptor. Cases: The cases were 5 patients who have recently been treated with SSRIs and presented with bruxism. Low- dose quetiapine (between 25 and 50 mg daily) was prescribed for the patients, and after a few days, they reported no bruxism and continued taking the medication. Conclusion: We found that quetiapine can improve bruxism and mandibular dystonia, which are side effects of SSRIs.